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A survey of GPs in England on the rationing of health care

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Background• The Nuffield Trust, an independent health think tank, and Doctors.net.uk, the largest online professional network of doctors, have conducted a survey of GPs in England to test opinion on whether – given the financial challenge facing the NHS – they believe the NHS will have to further restrict what is, and what is not, available to patients free at the point of use.• The survey has been timed to coincide with the publication of a new Nuffield Trust report: Rationing health care: Is it time to specify more clearly what is funded by the NHS? The report examines the feasibility as well as advantages and disadvantages of setting out explicitly the limits to the care patients are entitled to.

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Methodology• The survey conducted by the Nuffield Trust and Doctors.net.uk – known as the ‘medeConnect GP omnibus’ – is a regular monthly, online study of doctors drawn from the Doctors.net.uk community.• A regionally representative sample of 1,009 UK GPs took part in the survey – of which 821 are practising in the NHS in England. As the issues raised in the survey are most pertinent to the English NHS, all results included in this slideshow relate to the 821 GPs in England alone.• The February 2012 omnibus ran from the 15 to 21 February.

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Q1. In the next 5 years the NHS will have to set out more clearlywhat is – and what is not – available to patients free at the pointof use on the NHS.

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Q2. Over the next five years the NHS can be made more efficient so thatthe services funded by the NHS free at the point of use are not curtailedmore than they are at present.

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Q3. Making clinical commissioning groups (CCGs) responsible for settingpriorities for spending NHS funds is likely to lead to greater variations in whatservices are provided to patients throughout the NHS in England.

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Q4. Who do you think should be responsible for ultimately decidingwhich services should – and should not be – funded and available topatients free at the point of use in the NHS in England?

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Rationing health care: Is it time to specify more clearly whatis funded by the NHS?• The Nuffield Trust report draws out learning for the NHS from countries that have sought to set out explicitly the health care benefits that are paid for by their publicly funded health system.• It outlines a range of problems with the current system for determining which treatments are, and are not, funded by the NHS. These include: a lack of transparency around how spending decisions are made and variations in funding decisions.• The report stops short of recommending the Government draws up an explicit account of what health care is and what is not funded, ruling it out on the grounds that it would risk compromising the principle of solidarity on which the NHS relies.

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Continued…However, the report makes several recommendations for how thesystem could be improved so that, among other things,perceptions of unfairness could be avoided. These include:• Establishing a set of principles that would shape how public money is spent in the NHS;• Producing a national list of the treatments that public money should not be spent on in the NHS;• Ensuring decisions in CCGs are transparent and clinicians are ‘nudged’ towards clinical and cost effective care.The report is available to download fromwww.nuffieldtrust.org.uk/publications/rationing-health-care